Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.

Thursday, August 26, 2010

Very Little Very Sad People

I thought I'd give you a heads up that The New York Times Magazine will be featuring an article on Preschooler Depression this weekend. I am working on my ability to see into the future, and it's going well.

Pamela Paul will write:

Diagnosis of any mental disorder at this young age is subject to debate. No one wants to pathologize a typical preschooler’s tantrums, mood swings and torrent of developmental stages. Grandparents are highly suspicious; parents often don’t want to know. “How many times have you heard, ‘They’ll grow out of it’ or ‘That’s just how he is’?” says Melissa Nishawala, a child psychiatrist at the New York University Child Study Center.

And some in the field have reservations, too. Classifying preschool depression as a medical disorder carries a risk of disease-mongering. “Given the influence of Big Pharma, we have to be sure that every time a child’s ice cream falls off the cone and he cries, we don’t label him depressed,” cautions Rahil Briggs, an infant-toddler psychologist at Children’s Hospital at Montefiore in New York. Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. “They want to give these kids medicines, but we can’t figure out the diagnoses.” As Daniel Klein warns, “Right now the problem may be underdiagnosis, but these things can flip completely.”

Leave to psychiatrists and Pharma to want to medicate preschoolers. At this young age, somebody might instead look and see if the child is being held and loved enough, hit and screamed at too much, or have other home difficulties. Medicate?! We may have given up on trying to get adults over the childhood trauma they experienced and just stuff pills down them, but when the kid still IS in childhood, shouldn't somebody try to change the life path they tikes follow? The only problem with my idea is that parents may say they are perfect parents. I know mine would have.

You know, I can't help but to feel that if only there was further understanding about NON pharmaceutical avenues in the medical world, it wouldn't be such a BIG deal to diagnose reality as it is. If you have a depressed, anxious or bi polar child...there is NOTHING worse than having the experts neglect proper diagnosis because then you have ZERO support. In fact, then it just gets blamed on your parenting or something like that. I have a son who has been bi polar all his life. I looked for answers, and got none. Not until he suffered a brain injury at 17...and then, it was TOO LATE and COMPLETELY unhelpful to be told..."Oh...your son is bi-polar." All the pieces of the puzzle flowed together, all the comments about "parenting skills" flew out the window, and all we were left with was a son that COULD have been and SHOULD have been helped. If not with medication, with therapy, yoga, meditation, DBT....ANYTHING...it didn't have to be drugs...it just had to be awareness. Awareness of what he was going through in his brain would have helped us to understand that he wasn't "misbehaving", and that we weren't parenting poorly. All the blame, avoidance and frustration could have been avoided by the understanding that our child was bi-polar. We could have done something. It didn't have to be drugs. It could have just been the aid of awareness.

But, since all doctors have in their pockets are medications without knowledge of healing, alternative therapies, or holistic avenues, children will go undiagnosed to protect them from toxic drugs.

For the record...my son does Yoga, DBT and visits a naturopath now...she has done more for his mental health than any other doctor. Not only is she helping him stabilize his moods without toxic meds, she is helping his brain to heal beautifully. Even the docs notice the change.

When we accept that there is more to life than allopathic medicine, healing is possible. When we understand that children can and DO suffer from mental health issues...we can help them better.

I wish I had known before my son had a head injury. I wish I'd known he wasn't just being defiant.

I don't know, I just can't advocate medicating toddlers. They are too young, we don't know how drugs will affect their brain development, and we know nothing about safety profiles in that age group. Toddlers also can't communicate clearly with us as far as what they're experiencing - side effects, etc - as a result. It's a dangerous step. We also know there are other treatments - non-chemical ones - that can help. I think we're really obligated to try those first.

That said, my first clear thoughts of suicide - actual specific suicidal ideation, not just general thought - were in second grade. I'm not sure that medication would have been an appropriate treatment even then, but....no treatment didn't really work out that well.

I think we first need a more accurate and effective means of assessment. The one we have for young adults and adults is not all that great, and toddlers are not simply little adults.

I've read the article once (at The NYT ... so I read it here second) ;-) ... I will read it again. My first thoughts, though, arise from my own experience, and a lifetime (nearly 52 years) of working to figure out why I wanted to die at the age of five.

In my own situation, there was a six-week premature birth followed by three months spent in incubators and Isolettes (c. 1960). I was considered "medically fragile" and I was born in a time when the natural wisdom of skin-to-skin contact wasn't considered important. How we manage to miss the obvious in this culture continues to amaze me ...

Every Dx of depression includes countless factors, including what's going on in the wider culture. We still tend to aim the diagnostic arrows at what's going on inside a person, supposedly independent of everything going on *outside* the person, and what's being done *to* the person, either directly or through cultural / social / religious (etc.) osmosis ...

I was taken to a psychiatrist when I was about 16 months old. Apparently I was under this person's treatment until I was about six. I've never been informed of who this man was (I have no memory other than a fish tank, crayons and large, blank sheets of paper to draw on ); I've no idea if I was medicated; I've never been told of a diagnosis. Big blank space.

I've lived with major depression all my life, and have learned (through experience, therapy that ran the gamut from impeccable to horrendous, and my own professional training and practice) to focus on the simple, basic things like fluid and food intake; movement; breathing; lots of loving touch; the arts ...

I didn't say anything about medication, just that if other things are possible that young, anything could be. I'm not sure about medication that young, I'm really not. I think a variety of other therapeutic avenues should be the first things tried, at that age.

The only problem with my idea is that parents may say they are perfect parents. I know mine would have.I wish I had known before my son had a head injury. I wish I'd known he wasn't just being defiant.

Wait, so I re-read this article on preschooler depression. While medications were mentioned in passing, the treatment mentioned, something called PCIT, was a more cognitive treatment, and no where did it say that the children used as examples in the article were given medications....why do readers immediately jump on that?Or the issue that if a preschooler is sad, they must have bad, neglectful, non-affectionate, or violent parents? Why would anyone assume that from reading this article? If anything, the parents here seem concerned about their children, invested in getting them help, and open to the scrutiny of both the mental health system and an investigative reporter--why would physician parents allow this if they were beating their small child? If research eventually shows that sullen, distraught young children go on to have a lifetime of suffering with major depression, and safe treatments can abort/prevent/decrease present or future suffering, then why would this be bad? Even if the treatment was a medication---if it helped more than hurt, why immediately dismiss the idea as "not for the little peeps"? (I put my ? outside the quotations for Clink because I don't want to bicker.

You said, "Even if the treatment was a medication---if it helped more than hurt, why immediately dismiss the idea as "not for the little peeps"? (I put my ? outside the quotations for Clink because I don't want to bicker."

I know you said you don't want to bicker but when you write something like this, you're going to get responses. If you don't care to respond to what I said, that is fine but I am going to state my opinion.

As I said in a previous post in response to a point that movie doc made, I think the problem is that psychiatry's definition of how medications help is different from the patient's perspective.

And with parents in the equation advocating for kids, the issue becomes more complicated.

Personally, based on all the statistics I have seen that show that antidepressants only work in the short term if they work at all, I would find a hard time believing that medications would be helpful, particularly for kids, whose brain is still growing.

Psychiatry keeps claiming they work based on their experiences but if I said that about fish oil as an alternative health practitioner which I am not by the way, you would rightfully be all over me. But yet it is ok for you to do it without providing any evidence.

And if people still think I am just a crazy anti psych med crazy zealot popping off crazy rhetoric, please read this latest article by Robert Whitaker essentially showing the star d study which psychiatry touted as the golden standard was a sham:

In all fairness, Edmond Pigott, one of the study authors quoted in the Whitaker article, also appears to have a conflict:

http://www.neuro-advantage.com/contact

But before this study came out, Robert Whitaker had analyzed the data and pretty came to the same conclusion. He has a book to sell but I don't consider that a big deal and I would say that about anyone who wrote one whether I agreed or disagreed with it.

Finally, Dinah, you wonder why people are barking about medication and then you suggest it might be appropriate. Kind of proves the point, doesn't it?

Please understand that I am not saying that mental illness doesn't exist. But medications should be reserved in the most extreme of cases. But I greatly fear that based on big pharma's influence, that isn't going to happen and children will pay a heavy price for that.

"While medications were mentioned in passing, the treatment mentioned, something called PCIT, was a more cognitive treatment, and no where did it say that the children used as examples in the article were given medications....why do readers immediately jump on that?"

Because that is usually what happens as evidenced in the 400% jump of childhood bipolar disorder.

Also, Joan Luby, the psychiatrist quoted in the article appears to have some financial conflicts as she received money from Astra Zeneca. The company makes Seroquel, which has been used off label for childhood depression according to the Furious Seasons blog:

http://tinyurl.com/25pphcx

In all fairness, there are conflicts in alternative medicine too. I deplore them no matter how I feel about an issue.